Emergency medical services smart watch

ABSTRACT

A system comprising: a wrist-worn device configured to be worn on the wrist of a rescuer performing cardiopulmonary resuscitation (CPR), the wrist-worn device including: one or more sensors coupled with the wrist-worn device, the one or more sensors being configured to sense one or more parameters indicative of a fatigue level of the rescuer; and a sensor interface configured to provide the sensed parameters to one or more external computing devices via an interface; and a wearable computing device configured to be worn by a rescuer, the wearable computing device including: a device interface for receiving information related to CPR; and a display for displaying an indication of the received information.

CLAIM OF PRIORITY

This application claims priority under 35 USC §119(e) to U.S. PatentApplication Ser. No. 62/100,707, filed Jan. 7, 2015, and is acontinuation-in-part of and claims priority under 35 USC §120 to U.S.patent application Ser. No. 14/036,313, filed on Sep. 25, 2013, theentire contents of both of which are hereby incorporated by reference.

TECHNICAL FIELD

This document relates to cardiac resuscitation and, in particular, tosystems and techniques for assisting rescuers in performingcardio-pulmonary resuscitation (CPR).

BACKGROUND

CPR is a process by which one or more rescuers may provide chestcompressions and ventilation to a victim who has suffered an adversecardiac event—by popular terms, a heart attack. During the first five toeight minutes after CPR efforts begin, chest compressions are consideredto be the most important element of CPR because chest compressions helpmaintain circulation through the body and in the heart itself.

CPR may be performed by a team of one or more rescuers, particularlywhen the rescuers are professionals, such as emergency medicaltechnicians (EMTs) on an ambulance crew. One rescuer can provide thechest compressions while another can provide and time their ventilationsof the victim to match the chest compressions according to theappropriate CPR protocol. When professionals such as EMTs provide thecare, ventilation is more likely to be provided via a ventilation bagthat a rescuer squeezes rather than by mouth-to-mouth. CPR can beperformed in conjunction with shocks to the patient provided by anexternal defibrillator, such as from an automatic external defibrillator(AED) that is designed to be used by laypeople. Such AEDs often provideaudible information to rescuers, such as “push harder” (when the rescueris not performing chest compressions forcefully enough), “stop CPR,”“stand back” (because a shock is about to be delivered), and so on. Inorder to determine how chest compressions are being performed, certaindefibrillators may obtain information from one or more accelerometers(such as in the CPR D PADZ, CPR STAT PADZ, and ONE STEP pads made byZOLL MEDICAL of Chelmsford, Mass.) that can be used to compute depths ofchest compression (e.g., to determine that the compressions are tooshallow to be effective and to thus cause the verbal cue “push header”to be spoken by the defibrillator).

SUMMARY

This document describes systems and techniques that may be used to helpmanage the response to an emergency medical event. Feedback is providedto a rescuer (e.g., a rescuer performing CPR) via a smart watch platformor other wrist-worn device. For example, CPR feedback, such as rate,depth, and CPR interval time, can be displayed on a high pixel densityand curved form factor device worn on the rescuer's wrist. Additionalfeedback, such as release velocity, victim heart rate, inspired carbondioxide, and/or ventilation prompts, can additionally or alternativelybe displayed on the high pixel density and curved form factor device.Other patient information such as ECG or other measured parameters canadditionally be displayed. One example of such a high pixel density andcurved form factor display is an indium gallium zinc oxide-baseddisplay. The wrist-worn device can communicate with a defibrillator orother computing device using a short-range wireless protocol that allowsfor the combination of high-speed communications and low standby power,such as the Bluetooth 4 protocol.

This document also describes systems and techniques that may be used tohelp manage the work by teams of rescuers who are responding to a victimor person in need of emergency assistance. For example, typically, suchteams include a pair of rescuers, where the first of the rescuersperforms CPR chest compressions on the victim and the other performsventilations, either by mouth-to-mouth techniques or using a flexibleventilator bag. Frequently, a good heartbeat cannot be establishedquickly for the victim so CPR must be carried out for many minutes inorder to maintain perfusion of blood in the victim. In such situations,rescuers can tire after only a minute or two of providing chestcompressions, so certain protocols call for the rescuers to switch rolesperiodically. The systems and techniques discussed here are implementedwith recognition that different people have different levels of staminafor performing chest compressions and other components of CPR, such asventilating a victim or administering drugs to the victim. As a result,the techniques discussed here monitor the physical state of the rescuer,(e.g., by monitoring the heart rate or blood pressure of the rescuer)and tell the rescuers to switch out when the rescuer data indicates thatthe CPR might be, or would be, better performed by the other rescuer dueto tiring of the initial rescuer. This feedback to switch rescuers isprovided to a rescuer on a flexible, wrist-worn device, such as a smartwatch.

In certain implementations, systems and techniques described herein mayprovide one or more advantages. For example, a patient may be providedwith the best care that is available from the rescue team throughout arescue episode. For example, a rescuer with greater stamina may be leftperforming chest compressions longer than another rescuer with lessstamina, whereas, alternatively, they might have been allowed to performfor equal time periods, leading to a substandard performance caused byusing techniques other than those described here. Also, the terms ofeach cycle may change as the rescue continues based on the level ofphysical exertion of the rescuer and the rescuer's physical stamina.Such adjustments may be dynamic and need not rely on a static timedschedule. The instructions to switch may also be provided in a clear andsimple manner (and in a variety of manners, such as a visual displayworn by the rescuer performing chest compressions), so that evenrescuers in a high-stress environment can get the message. In addition,in certain implementations, the techniques described here can beimplemented as part of an automatic external defibrillator (AED) or aprofessional defibrillator, or in a dual-mode defibrillator. As aresult, the clinical performance of a rescuing team can be increased,and patient outcomes improved.

In one aspect, a system includes a wrist-worn device configured to beworn on the wrist of a rescuer performing cardiopulmonary resuscitation(CPR). The wrist-worn device includes one or more sensors coupled withthe wrist-worn device. The one or more sensors are configured to senseone or more parameters indicative of a fatigue level of the rescuer. Thewrist-worn device also includes a sensor interface configured to providethe sensed parameters to one or more external computing devices via aninterface. The system also includes a wearable computing deviceconfigured to be worn by a rescuer. The wearable computing deviceincludes a device interface for receiving information related to CPR,and a display for displaying an indication of the received information.

Implementations can include one or more of the following features.

In some implementations, the wrist-worn device includes a wrist-worndisplay formed of a flexible material configured to wrap around thewrist, and a controller arranged to receive information related to CPRfrom at least one of the sensors and external computing devices anddisplay an indication on the wrist-worn display related to the receivedinformation.

In some implementations, the wearable computing device receives theinformation related to CPR from the wrist-worn device.

In some implementations, the wearable computing device receives theinformation related to CPR from one or more of the external computingdevice.

In some implementations, in response to sensing the one or moreparameters indicative of a fatigue level of the rescuer, the deviceinterface is configured to receive an indication to switch rescuers. Thewearable computing device is configured to display an indication on thedisplay related to the received indication to switch rescuers.

In some implementations, the wearable computing device includes wearableglasses.

In some implementations, the display is formed on at least one lens ofthe wearable glasses.

In some implementations, the wrist-worn device includes a band formed ofmultiple springy metal bands.

In some implementations, the one or more sensors include sensorsconfigured to monitor at least one of a heart rate and blood pressure ofthe rescuer.

In some implementations, the system includes an electronic patientmonitor. The system also includes a sensor interface on the electronicpatient monitor arranged to receive input from one or more sensors thatsense one or more parameters indicative of a CPR quality level. Thesystem also includes a CPR monitor in the electronic patient monitorconfigured to use the input from the sensors to identify a qualityparameter and to provide information associated with the qualityparameter to the wrist-worn device.

In some implementations, the electronic patient monitor is part of anexternal defibrillator.

In some implementations, the CPR monitor includes a microprocessorconnected to an electronic memory that stores instructions that, whenexecuted, perform a process of identifying a quality parameter thatreflects one or both of a depth of chest compressions and a rate ofchest compression.

In some implementations, the display is configured to provide feedbackto a rescuer indicating a way to improve a CPR component.

In some implementations, the wrist-worn device includes a memoryconfigured to store a unique identifier associated with the wrist-worndevice.

In some implementations, the wrist-worn device is configured to power onwhen the wrist-worn device wraps around the wrist.

In some implementations, the system includes a heads-up device toprovide feedback to a user related to CPR performance based on the oneor more parameters associated with the CPR performance.

In another aspect, a system includes a wrist-worn device configured tobe worn on the wrist of a rescuer performing CPR. The wrist-worn deviceincludes one or more sensors coupled with the wrist-worn device. The oneor more sensors are configured to sense one or more parametersindicative of a fatigue level of the rescuer. The wrist-worn device alsoincludes a sensor interface to provide the sensed parameters to one ormore external computing devices via an interface. The system alsoincludes a heads-up device configured to be viewed by a rescuer. Theheads-up device includes a device interface for receiving informationrelated to CPR, and a display for displaying an indication of thereceived information.

Implementations can include one or more of the following features.

In some implementations, the display is configured to present theindication via a projected image.

In another aspect, a method includes monitoring, with a sensor coupledwith a wrist-worn device, one or more parameters indicative of a statusof a user wearing the wrist-worn device. The method also includesdetermining a fatigue score related to a level of fatigue of the user.The method also includes determining whether the user is exhibitingfatigue based on the fatigue score. The method also includes providingan indication to the user that a different user should perform a CPRcomponent.

Implementations can include one or more of the following features.

In some implementations, the method includes repeating the actions ofmonitoring, determining, and providing, while multiple different usersare instructed to perform the CPR component.

In some implementations, the CPR component includes chest compressions.

In some implementations, the method includes sending, to a wearablecomputing device worn by the user, information related to the CPRcomponent.

In some implementations, the wearable computing device includes wearableglasses.

In some implementations, a display is formed on at least one lens of thewearable glasses.

In some implementations, the information related to the CPR componentincludes one or more parameters indicative of a quality level of the CPRcomponent. The one or more parameters include one or more of depth ofcompression and rate of compression. Determining the fatigue scoreincludes determining the fatigue score based on the one or moreparameters. The one or more parameters also indicate a physical statusof the user.

In some implementations, the method includes generating a chestcompression quality score based on one or both of the rate ofcompression and the depth of compression. The method includes providingan indication of the chest compression quality score to the wearablecomputing device.

In some implementations, the method includes providing periodic feedbackto the user by causing information representing one or both of chestcompression depth and chest compression rate to be presented on thedisplay.

In some implementations, the status includes a physical status.

In some implementations, the method includes transmitting the fatiguescore to a central management system.

In another aspect, a method includes receiving, from a sensor coupledwith a wrist-worn device, one or more parameters indicative of a statusof a user wearing the wrist-worn device. The method also includesdetermining, based on the one or more parameters, a fatigue indicationassociated with a fatigue level of the user. The method also includessending, to a wearable computing device, information to cause thewearable computing device to provide an indication to the user that adifferent user should perform a CPR component.

Implementations can include one or more of the following features.

In some implementations, the CPR component includes chest compressions.

In some implementations, the wearable computing device includes wearableglasses.

In some implementations, the method includes receiving one or moreparameters indicative of a quality level of the CPR component. The oneor more parameters include one or more of depth of compression and rateof compression. Determining the fatigue indication includes determiningthe fatigue indication based on the one or more parameters. The fatigueindication is indicative of a physical status of the user.

In some implementations, the method includes receiving informationrelated to one or both of a depth of chest compressions and a rate ofchest compressions. The method also includes generating a chestcompression quality score based on one or both of the depth of chestcompressions and the rate of chest compressions. The method alsoincludes sending, to the wearable computing device, information to causethe wearable computing device to display information representing thechest compression quality score.

In some implementations, the status includes a physical status.

In another aspect, a computer readable medium stores instructions forcausing a computing system to monitor, with a sensor coupled with awrist-worn device, one or more parameters indicative of a status of auser. The instructions also cause the computing system to determine afatigue score related to a level of fatigue of the user of thewrist-worn device. The instructions also cause the computing system todetermine that the user is exhibiting fatigue based on the fatiguescore. The instructions also cause the computing system to provide anindication that a user other than the user of the wrist-worn deviceshould perform a CPR component.

Implementations can include one or more of the following features.

In some implementations, the instructions cause the system to cyclicallyrepeat the actions of monitoring, determining, and providing, whilemultiple different users are instructed to perform the CPR component.

In some implementations, the CPR component includes chest compressions.

In some implementations, the indication is provided to a wearablecomputing device that includes wearable glasses.

In some implementations, a display is formed on at least one lens of thewearable glasses.

Other features and advantages will be apparent from the description anddrawings, and from the claims.

DESCRIPTION OF DRAWINGS

FIG. 1 is an overhead view of rescuers performing CPR on a victim usingan electronic system that instructs them in their performance of theCPR.

FIGS. 2A and 2B show exemplary smart watches displaying informationassociated with a rescue attempt.

FIG. 3 shows a portable defibrillator and ancillary components arrangedto provide feedback and instruction to rescuers.

FIG. 4 shows an exemplary device including a display, sensors, and acommunication module configured to be worn on the wrist of a rescuer.

FIG. 5 shows an exemplary smart watch displaying an indication that theprovider of care should change.

FIG. 6 is a flowchart of a process for monitoring rescuer status andproviding an indication of when the provider of care should change.

FIG. 7 is an overhead view of rescuers performing CPR on a victim usingan electronic system that instructs them in their performance of theCPR.

FIG. 8 is a flowchart of a process for joining a network.

FIG. 9 is an overhead view of rescuers performing CPR on a victim usingan electronic system that instructs them in their performance of theCPR.

DETAILED DESCRIPTION

This description discusses systems and techniques for guiding theprovision of care to a patient, such as the provision of CPR to a victimof cardiac arrest. For example, a portable electronic defibrillator maybe provided to rescuers and may include common features for deliveringdefibrillating energy (a shock) to a victim of cardiac arrest throughelectrodes that may be placed on the torso of the victim. Thedefibrillator may also be provided with a mechanism for sensing themanner in which CPR chest compressions are performed on the victim, suchas a puck or similar item that includes an accelerometer, which may beplaced under the hands of the person performing chest compressions andon top of the sternum of the victim. The defibrillator may useinformation from such an item to identify the depth and rate of chestcompressions that are being performed by a rescuer. Feedback can beprovided to the rescuer via a curved form factor display worn on thewrist of the rescuer such as a smart watch with an indium gallium zincoxide high pixel density display.

In some embodiments, the wrist-worn device can include one or moresensors to track the physiological state of the rescuer by monitoringfactors of the rescuer such as pulse and blood oxygen level. Thisinformation can be used to assess the fatigue level of the rescuer andmake a determination as to when multiple rescuers at the scene of therescue event should switch performing CPR. When the defibrillator makesa determination that the rescuer is suffering from fatigue, thedefibrillator may provide an indication to that rescuer that he or sheshould step away and allow another rescuer to perform chest compressionsfor a time. Such an indication can be provided through the smart watchworn by the rescuer. For example, where there are two rescuers, thesecond rescuer may have been providing ventilation to the victim using aventilation bag and may be simultaneously prompted to change and providechest compressions, while the first rescuer takes over operation of thebag.

FIG. 1 is an overhead view of rescuers 104, 106 performing CPR on avictim 102 using an electronic system that instructs them in theirperformance of the CPR. Each of the rescuers 104, 106 wears a wrist-worndevice 120, 122, such as a smart watch, with a curved form factordisplay 121, 123. The wrist-worn devices 120, 122 include one or moresensors to sense one or more activities associated with the CPRperformance and may also provide feedback to the rescuers performing theCPR on the victim 102. In this instance, each of the rescuers 104, 106also wears a wearable computing devices 125, 127 in the form of a pairof glasses. The wearable computing devices 125, 127 provide feedback tothe rescuers performing CPR on the victim 102. For example, a deviceinterface 126 (integrated into the wearable computing device 127) canreceive information from the wrist-worn devices 120, 122 and/or one ormore external devices, and display information such as feedback to therescuer 106 on a display 128.

In this example, rescuers 104, 106 are already in position and providingcare to the victim 102, with rescuer 104 and providing chestcompressions to the torso of the victim 102, and rescuer 106 providingventilation using ventilation bag 112. The rescuers 104, 106 may be layrescuers who were in the vicinity of the victim 102 when the victim 102required care, or may be trained medical personnel, such as emergencymedical technicians (EMTs). Although two rescuers are shown here forpurposes of explanation, additional rescuers may also care for thevictim 102.

Control and coordination for the resuscitation event and the delivery ofthe various therapies may be accomplished by a device or processingelement that is external to the defibrillator 108, such as by use of atablet-based computer that is controlled by one of the rescuers. Forinstance, the device may download and process ECG data from thedefibrillator 108, analyze the ECG signals, perform relevantdeterminations based on the analysis, and control the other therapeuticdevices. In other examples, the defibrillator 108 may perform all theprocessing of the ECG, including analyzing the ECG signals, and maytransmit only the final determination of the appropriate therapy to aseparate device, whereupon the separate device can perform the controlactions on the other linked devices.

An electrode assembly 110 is shown on the victim 102 in a normalposition. The electrode assembly 110, in this example, is an assemblythat combines an electrode positioned high on the right side of thevictim's torso, a separate electrode positioned low on the left side ofthe victim's torso, and a sensor package located over the victim'ssternum. The sensor package, which, in this example, is obscured in thefigure by the hands of rescuer 104 may include an accelerometer orsimilar sensor package that may be used in cooperation with a computerin the defibrillator 108 to monitor performance of the chestcompressions.

The defibrillator 108 in this example is connected to the electrodepackage 110 and may operate in a familiar manner (e.g., to providedefibrillating shocks to the electrode package 110). As such, thedefibrillator may take a generally common form, and may be aprofessional style defibrillator, such as the R-SERIES, M-SERIES, orE-SERIES from ZOLL Medical Corporation of Chelmsford, Mass., or anautomated external defibrillator (AED), including the AED PLUS, or AEDPRO from ZOLL Medical Corporation.

The defibrillator or a computing device associated with thedefibrillator communicates wirelessly with the wrist-worn devices 120,122, the wearable computing devices 125, 127 or other types of wearablecomputing devices to present information to the rescuers. For example,information can be visually presented on the displays 121, 123, 128.Additionally, vibrators or audible sound generators on the wrist-worndevices 120, 122, the wearable computing devices 125, 127, etc. canprovide feedback. Such feedback, as discussed more fully below, mayinclude information about physical status of the victim 102 andperformance of CPR.

The wrist-worn devices 120, 122 can be smart watches (e.g., computerizedwristwatches with functionality enhanced beyond timekeeping). Such asmart watch can effectively be a wearable computer. The smart watch caninclude a data processor, memory, input, and output. The smart watchcollects information from internal sensors. It may control or retrievedata from other instruments or computers. For example, the smart watchcan support wireless technologies, like Bluetooth and/or Wi-Fi, tocommunicate with the defibrillator 108 or another computing device. Insome cases, the defibrillator 108 or another computing device can,automatically or in response to a user input and/or request, determineif a wearable computing device or another computing device is nearby,and establish a communication link with the wearable computing device oranother computing device in response to that determination. In someexamples, the smart watch may also serve as a front end for a remotesystem and be configured to display information generated by thedefibrillator or associated computing device. For example, the smartwatch and/or wearable computing device may be configured to displayinformation from other instruments or computers, e.g., other wearabledevices. In this example, the smart watch and/or wearable computingdevice can display information relating data collected by the internalsensors of other wearable computing devices, smart watches, instruments,and/or equipment. This feature can allow a user supervising the rescueefforts to use a wearable computing device, e.g., a watch, to monitorthe multiple rescuers by receiving and displaying data captured by thepersonal computing devices of each rescuer.

The displays 121, 123 in the wrist-worn devices 120, 122 can be made ofIndium gallium zinc oxide (IGZO), a semiconducting material, etc. IGZOthin-film transistors (TFT) can be used in the TFT backplane offlat-panel displays (FPDs). Because the IGZO display is flexible, agreater amount of information can be displayed on the wrist-worn devices120, 122 due to the increased surface area of the display.

Along with being a pair of wearable glasses in some arrangements, thewearable computing devices 125, 127 can provide a variety offunctionality and include various types of components. For example, thedevice interface 126 of the wearable computing device 127 can includeone or more of the following: a data processor, memory, input, andoutput. The wearable computing devices can control or retrieveinformation from the wrist-worn devices 120, 122 or from otherinstruments or computers. In other examples, wearable computing devicesmay serve as a front end for a remote system and be configured todisplay information generated by the defibrillator or associatedcomputing device. For example, the defibrillator 108 can sendinformation about the performance of chest compressions, such as depthand rate information for the chest compressions to the wearablecomputing devices 125, 127. The wearable computing devices 125, 127 canalso receive data from the other sensors associated with the victim 102such as an airflow sensor provided with a ventilation bag. The wearablecomputing devices 125, 127 can also receive data from wrist-worn devices120 and 122 worn by rescuers 104 and 106 respectively. The informationfrom wrist-worn devices watches 120 and 122 can include informationabout the fatigue level of the rescuer (e.g., as described herein). Insome examples, the wearable computing devices 125, 127 are configured todisplay information and provide feedback about the CPR performance ofthe user wearing the glasses. In other examples, the wearable devices125, 127 can additionally or alternatively display information andfeedback relating to multiple rescuers, e.g., rescuers 104, 106, ordisplay information and feedback pertaining to another rescuer. In theseexamples, wearable computing device 127, for example, can displayinformation and provide feedback relating the performance of the rescuer106, to both rescuers 104 and 106 respectively, and/or relating to therescuer 104.

A wearable computing device can provide the functionality of receiving,transmitting, and/or displaying data. Data processing may also beprovided by such a wearable computing device (e.g., processing receiveddata prior to display, processing data prior to sending to anothercomputing device, etc.). In some instances, a wearable computing devicecan take the form of a head-mounted device that can include frameelements including lens-frames, a center support, one or more lenses,and side supports (for securing the device to a user). The wearablecomputing device may additionally include an on-board computing system,a still or video camera (mountable to the device at various locations),speakers, etc. The on-board computing system may have the capability tocommunicate with other computing devices, systems, etc. external to thewearable computing device, e.g., through a wireless network connection,a short-range (e.g., Bluetooth) connection, a cellular connection, oranother type of connection.

Various techniques may be employed to exchange information between thewearable computing device and the wearer. For example, the wearablecomputing device may include one or more displays that may be coupled tothe device. Such a display may be formed on one lens or multiple lensesof the wearable computing device and may be configured to overlaycomputer-generated images, graphics, etc. in the user's view of thephysical world. The display can be positioned at one or more locationsof the lens or lenses, for example, at the center of one or more of thelens. In general, the display is controllable by the on-board computingsystem and is in communication with the computing system by employingone or more data transmission techniques (e.g., an optical waveguide orfiber, electrical conductor, etc.). In some arrangements, the frame ofthe wearable computing device can be similar to a frame of a pair ofglasses (e.g., prescription glasses, sunglasses, reading glasses, etc.).In some instances, the lenses incorporated into the device may be lessthan a completely formed lenses typically included in eyeglasses. Due tothe less than complete lens or lenses, the device may not include alower frame portion typically used to secure a complete lens to theframe.

To interact with the wearable computing device, one or more techniquesmay be employed. For example, a touch-based input (e.g., a touchpad) maybe incorporated to sense the position and movement of a user's finger bycapacitive sensing, resistance sensing, or other techniques. Equipment(e.g., one or more acceleration sensors) may be incorporated to sensethe movement of a portion of the user (e.g., the user's head). One ormore microphones may also be incorporated into the device to collectaudible signals (e.g., voice commands) from the user. Similar to sensingposition and movement, the direction of a user's finger (interactingwith the touch-based input), the level of applied pressure, etc. may besensed by interacting with device input.

In some arrangements, the wearable computing device can providenetworking functionality. For example, the wearable device can be usedto provide a node of a network architecture (e.g., a node for a meshnetwork). As such, information can be exchanged with (e.g., transmittedto, received from) other network nodes (e.g., other wearable computingdevices at nearby locations, mobile computing devices, medical devicessuch as defibrillating systems, wearable medical devices, etc.). In onearrangement, multiple members of an emergency response team may each beoutfitted with a wearable computing device that provides a network node.By employing data transmission techniques (e.g., one or more networkprotocols), information may be shared among the wearable computingdevices, e.g., so each member is provided the same information duringthe emergency or so that information can be exchanged among membersduring the emergency.

Such capabilities may be incorporated into other types of wearablecomputing devices, such as a timepiece (e.g., a watch), an ear piece, anarticle of clothing or protective medical gear, etc.

In some examples, the emergency medical technician can interact with acomputing device in the form of a heads-up device 103. The heads-updevice 103 may include a graphical display 105 by which information isreported to the emergency technician. In some cases, the graphicaldisplay 105 includes a transparent plane upon which an image and/orgraphic can be projected. The graphical display 105 can be attached orremovably attached to the heads-up device 103. The emergency technicianmay interact with the heads-up device 103 to enter data into the system100, receive feedback about the ongoing rescue efforts, or to receiveguidance about the ongoing rescue efforts. The heads-up device 103 mayinclude a device interface 107 for executing operations such ascoordinating with the other components of the heads-up device 103 (e.g.,exchange information, control signals, etc.), controlling of userinterfaces, applications executed by heads-up device 103, exchanginginformation with other devices (e.g., wirelessly communicate with otherdevices), etc.

The heads-up device 103 may be configured to provide information to theemergency technician while allowing the emergency technician to view thesurrounding environment in a generally unobstructed manner. For example,the heads-up device 103 may be configured to overlay computer-generatedimages, graphics, etc. in the user's view of the physical world.

The heads-up device 103 may also include a wireless transceiver forcommunicating with a wireless network, such as a 3G or 4G chipset thatpermits long distance communication over cellular data networks, andfurther through the internet. In some examples, the heads-up device 103is used in combination with one or more wearable devices.

To interact with the heads-up device 103, one or more techniques may beemployed. For example, a touch-based input (e.g., a touchpad) may beincorporated to sense the position and movement of a user's finger bycapacitive sensing, resistance sensing, or other techniques. Equipment(e.g., one or more acceleration sensors) may be incorporated to sensethe movement of a portion of the user (e.g., the user's head or theuser's hands). Specific user motions may be associated with specificinputs. For example, a specific motion may cause the device to powercycle. One or more microphones may also be incorporated into the deviceto collect audible signals (e.g., voice commands) from the user. Similarto sensing position and movement, the direction of a user's finger(interacting with the touch-based input), the level of applied pressure,etc. may be sensed by interacting with device input.

In some arrangements, the heads-up device 103 can provide networkingfunctionality. For example, the heads-up device 103 can be used toprovide a node of a network architecture (e.g., a node for a meshnetwork). In one arrangement, multiple members of an emergency responseteam may each be outfitted with a wearable computing device that alsoprovides a network node. By employing data transmission techniques(e.g., one or more network protocols), information may be shared amongthe wearable computing devices and the heads-up device 103, e.g., soeach member is provided the same information during the emergency or sothat information can be exchanged among members during the emergency.

While the heads-up device 103 is generally described as a separatedevice, it may be attached or removably attached to another device. Forexample, the heads-up device 103 may be attached or removably attachedto a portable defibrillator.

For illustrative purposes, two particular examples of feedback providedto a rescuer on the display of the wrist-worn devices are shown in FIGS.2A and 2B.

As shown in FIG. 2A, a wrist-worn device 200 can provide informationabout the physiological state of the patient, as well as informationabout the quality of the CPR being performed by the rescuer. Thewrist-worn device 200 includes a display for presenting CPR information.The CPR information may be automatically displayed when compressions aredetected. The displayed information about the chest compressions caninclude rate of compressions 206 (e.g., number of compressions perminute) and depth of compressions 204 (e.g., depth of compressions ininches or millimeters). The rate and depth of compressions can bedetermined by analyzing accelerometer readings. Displaying the actualrate and depth data (in addition to, or instead of, an indication ofwhether the values are within or outside of an acceptable range) canprovide useful feedback to the rescuer. A visual indicator 207, such asa color of the text or an applied highlighting, can be modified toindicate when a value for the depth and/or rate is outside of thepreferred range. For example, if the rate of 88 compressions per minuteas shown in FIG. 2A is too fast, the visual indicator 207 may include ared highlight indicating that the rescuer should slow down.

The displayed information about the chest compressions can also includea perfusion performance indicator (PPI) 208. The PPI 208 has a shape(e.g., a diamond) that is colored or shaded over time. The amount of theshape that is colored or shaded (e.g., the fill amount) providesfeedback about both the rate and depth of the compressions. For example,when CPR is being performed adequately, the entire indicator may befilled. As the rate and/or depth decreases below acceptable limits, theamount of fill lessens. The PPI 208 provides a concise visual indicationof the quality of the CPR such that the rescuer can aim to keep the PPI208 completely filled.

In some implementations, the PPI 208 includes two axes—a vertical axisand a horizontal axis. The vertical axis may correspond to the depth ofchest compressions, and the horizontal axis may correspond to the rateof chest compressions. For example, when the depth of chest compressionsdecreases below the acceptable limit, the fill amount of the PPI 208 inthe vertical direction may be relatively small. Similarly, when the rateof chest compressions decreases below the acceptable limit, the fillamount of the PPI 208 in the horizontal direction may be relativelysmall. For example, if the depth of chest compressions is adequate butthe rate of chest compression is below the acceptable limit, the fillamount of the PPI 208 may appear as a tall, thin diamond; if the depthof chest compressions is below the acceptable limit but the rate ofchest compressions is adequate, the fill amount of the PPI 208 mayappear as a short, wide diamond. Alternatively, the wearable device mayfurther provide a score (e.g., a chest compression quality score)indicative of the overall quality in the performance of CPR whichcondenses multiple parameters/data (weighted or unweighted) monitoredduring the act of CPR and/or shortly thereafter, so as to improve futureCPR. The chest compression quality score may be generated based on oneor both of chest compression rates and chest compression depths.

The wrist-worn device 200 may be configured to display a filtered ECGwaveform 202. In some examples, the filtered ECG waveform 202 can fillthe entire span of the display. In some examples, other waveforms canalso be displayed. For example, in some implementations, a secondwaveform (e.g., a CO2 waveform, a volumetric CO2 waveform, an ETCO2waveform, a SpO2 waveform, etc.) is also displayed.

The data displayed by the wrist-worn device 200 can change based on therescuer's actions. For example, the data displayed can change based onwhether or not the rescuer is currently administering CPR chestcompressions to the patient. In some examples, if multiple rescuers arepresent, this CPR information may be displayed to only the rescuer whois performing the CPR, and other information, such as patient dataand/or ventilation feedback, may be provided to the other rescuers.

As shown in FIG. 2B, the wrist-worn device 200 can additionally oralternatively provide concise, simplified feedback with instructions tothe rescuer regarding how to perform CPR. In this example, thewrist-worn device 200 provides a reminder 220 regarding “release” inperforming chest compression. Specifically, a fatigued rescuer may beginto lean forward on the chest of a victim and not release pressure on thesternum of the victim at the top of each compression. This can reducethe perfusion and circulation accomplished by the chest compressions.The reminder 220 can be displayed when the system recognizes thatrelease is not being achieved (e.g., signals from an accelerometer showan “end” to the compression cycle that is flat and thus indicates thatthe rescuer is staying on the sternum to an unnecessary degree).

In some examples, the wrist-worn device 200 can be configured to provideother types of feedback to the rescuer. The reminder 820 can becoordinated with other feedback, and can be presented in an appropriatemanner to get the rescuer's attention. For example, the visualindication may be accompanied by vibration generated by the wrist-worndevice 200 in order to indicate that a rescuer is to stop and modify howhe or she is performing the CPR. For example, the wrist-worn device 200may be provided with mechanisms for vibrating the device similar tomechanisms provided for vibrating portable communication devices (e.g.,when an incoming telephone call is received on a smartphone). Suchvibrating may be provided so as to alert the user to particularinformation and/or minimize the amount of information that can distractother rescuers in the area.

In some examples, the wrist-worn device 200 can generate periodicvibrations felt by the user to synchronize the chest compressionactivities with the desired rate. For example, the vibrations may beperiodic occurring at the preferred chest compression rate (e.g.,approximate 100 times per minute) to indicate when the rescuer 104should be performing compressions. Such haptic feedback, when used toidentify urgent information or provide instructions, may also relievethe rescuer 104 of having to constantly monitor the informationdisplayed by the wrist-worn device 200. Thus, a first type of feedback,which may be (e.g., pulsed) visual, audible, or tactile, may be providedto signal the wearer of the wrist-worn device 200 to view informationdisplayed on the wrist-worn device 200.

In some examples, the wrist-worn device 200 includes an audio outputdevice such as a speaker for providing audible alerts and/ornotification. The speaker may emit periodic tones to synchronize thechest compression activities with the desired rate. For example, thetones may be periodic occurring at the preferred chest compression rate(e.g., approximately 100 times per minute) to indicate when the rescuershould be performing compressions. In some examples, the audible alertsand/or notifications may be indicative of the rescuer's performance withregard to depth of chest compressions. For example, the speaker mayprovide spoken feedback to the rescuer (e.g., “push harder” or “pushsofter”) if the rescuer is not administering the CPR appropriately.

In some examples, the wrist-worn device 200 includes a light (e.g., anLED) for providing visual alerts and/or notifications. The LED may emitperiodic flashes of light to synchronize the chest compressionactivities with the desired rate. For example, the flashes of light maybe periodic occurring at the preferred chest compression rate (e.g.,approximately 100 times per minute) to indicate when the rescuer shouldbe performing compressions. In some examples, the emitted light (e.g.,the color of the emitted light) may be indicative of the rescuer'sperformance with regard to depth of chest compressions. For example, theLED may emit red light if the chest compressions are too hard (e.g., toodeep), and the LED may emit a blue light if the chest compression aretoo soft (e.g., too shallow).

Two particular examples of feedback provided to a rescuer on the displayof the wrist-worn devices 200 have been described above for illustrativepurposes. However, similar feedback features may also be incorporatedinto the wearable computing devices 125, 127 of FIG. 1. For example, thedisplay 128 may present a filtered waveform, a depth of compressions, arate of compressions, a PPI, a visual indicator, and/or a reminderdirected to the rescuer. In some implementations, the wearable computingdevices 125, 127 include speakers and/or lights for emitting audibleand/or visual notifications directed to the rescuer.

In some implementations, the wearable computing device can presentfeedback information via the display. The displayed information caninclude the rate of compressions (e.g., number of compressions perminute) and the depth of compressions (e.g., depth of compressions ininches or millimeters). Displaying the actual rate and depth data (e.g.,in addition to or instead of an indication of whether the values arewithin or outside of an acceptable range) can provide useful feedback tothe rescuer. A visual indicator (e.g., similar to the visual indicator207 of FIG. 2A), such as a color of displayed text or an appliedhighlighting, can be modified to indicate when a value for the depth orrate is outside of the preferred range. For example, if the presentedrate is too fast, the visual indicator may include a red highlightindicating that the rescuer should slow down.

The displayed information about the chest compressions can also includea perfusion performance indicator (PPI) (e.g., similar to the PPI 208).The PPI can have a shape (e.g., a diamond) that is colored or shadedover time. The amount of the shape that is colored or shaded (e.g., thefill amount) can provide feedback about both the rate and depth of thecompressions. For example, when CPR is being performed adequately, theentire indicator may be filled. As the rate and/or depth decreases belowacceptable limits, the amount of fill lessens. The PPI can provide aconcise visual indication of the quality of the CPR such that therescuer can aim to keep the PPI completely filled. As discussed furtherherein, the wearable computing device may also aggregate multipleparameters/data monitored during the act of CPR to provide a score(e.g., a chest compression quality score), where the individualparameters/data may be weighted or unweighted, to indicate to a user theoverall quality in the performance of CPR, to improve the quality offuture CPR.

The display of the wearable computing device may be configured todisplay a filtered ECG waveform. In some examples, other waveforms canalso or instead be displayed.

In some implementations, the CPR feedback information may be related toa particular metric that has an unsatisfactory value (e.g., such thatthe chest compression quality score is negatively impacted by themetric). For example, if the depth of chest compressions has asatisfactory value but the rate of chest compressions is inadequate, thewearable computing device may provide feedback directed at theinadequate rate metric. The feedback may include a spoken messageemitted by a speaker of the wearable computing device (e.g., “slow down”or “speed up”). The feedback may include a periodic vibration indicativeof the desired rate of chest compressions, as described above withreference to the wrist-worn device 200 of FIGS. 2A-2B. The feedback mayinclude a visual indicator, such as a light flashing at a rate thatcorresponds to the desired rate of chest compressions.

In some implementations, the wearable computing device may be configuredto present the chest compression quality score and one or morecalculated metrics to the rescuer. The one or more calculated metricscan correspond to a CPR component (e.g., chest compressions). Anycombination of the chest compression quality score and the calculatedmetrics may be displayed continuously. Each of the calculated metricsmay be presented in a way that corresponds to the impact that theparticular metric has on the chest compression quality score. Forexample, calculated metrics that have a relatively negative impact onthe chest compression quality score may be presented in bold text, andcalculated metrics that have a relatively positive impact on the chestcompression quality score may be presented in non-bold text. Similarly,if the chest compression quality score is unsatisfactory, it may bepresented in bold text, and if the chest compression quality score issatisfactory, it may be presented in non-bold text. In this way, therescuer can quickly determine whether the CPR is being adequatelyadministered, and if not, the rescuer can quickly determine which of theCPR parameters additional attention should be afforded to.

By way of example, the chest compression quality score may be 86 (e.g.,86 out of 100). A score of 86 may be deemed satisfactory, and thus thechest compression quality score may be presented in non-bold text.However, there exists room for improvement of the chest compressionquality score. The depth metric may have a satisfactory value, and thusmay be presented in non-bold text. However, the rate metric may have anunsatisfactory value. Therefore, the rate metric may be presented inbold text. The bold text of the rate metric can serve to catch therescuer's attention, and the rescuer can focus on improving the metric(e.g., by speeding up or slowing down the rate of chest compressions).Once the rate metric has a satisfactory value, the bold text may becomeunbolded and the chest compression quality score may increaseaccordingly.

Over time, the rescuer may become tired. As a result, the rescuer may beunable to attain a sufficient depth of compressions. Continuing with theexample above, if the depth metric also assumes an unsatisfactory value,the chest compression quality score may decrease accordingly. If thechest compression quality score falls below a particular (e.g.,predetermined) threshold, the chest compression quality score may bepresented in bold text.

One or more other visual techniques may be employed instead of or inaddition to the bold/non-bold text feature described above. For example,in some implementations, each of the calculated metrics may be presentedas text having a color that correspond to the impact of the calculatedmetric on the chest compression quality score. For example, calculatedmetrics that have a relatively negative impact on the chest compressionquality score may be presented in red text; calculated metrics that havea relatively neutral impact on the chest compression quality score maybe presented in yellow text; and calculated metrics that have arelatively positive impact on the chest compression quality score may bepresented in green text. In this way, the rescuer can quickly determinewhether additional attention should be afforded to one or more of theCPR parameters. For example, a chest compression quality score having avalue of 86 may be presented in yellow text, indicating that the chestcompression quality score is within acceptable limits but there is roomfor improvement. The compression depth metric may be presented in greentext and the compression rate metric may be presented in red text. Basedon the text colors, the rescuer can quickly determine that the rate ofcompressions metric is unsatisfactory and is a major factor in the chestcompression quality score being suboptimal.

In some implementations, feedback may be provided only when one or moreaspects of the CPR performance is unsatisfactory. For example, if eachof the calculated metrics falls within acceptable ranges and the chestcompression quality score is acceptable, the wearable computing device(or, e.g., the wrist worn device 200 of FIGS. 2A-2B) may refrain fromproviding feedback to the rescuer so as not to distract the rescuer. Insome implementations, positive feedback is provided to the rescuer, butsuch positive feedback may be minimal so as not to distract the rescuer.

While the wearable computing devices 125, 127 have been shown in theform of wearable glasses, other wearable computing devices havingalternative configurations can also be used. For example, the wearablecomputing devices can include an exercise device and/or a mobilecomputing device such as a smartphone, a PDA, etc. that is configured tobe worn on a hand, wrist, and/or arm of the rescuer. For example, thewearable computing device may be a smartphone that can be attached to orplaced inside a band (e.g., a jogging band) to be worn by the rescuer.In some implementations, the wearable computing device is a fitnessdevice (e.g., a pedometer) that can be clipped onto the clothing of therescuer. The smartphone and/or the fitness device can be configured tooperate in a manner similar to that described above with reference toFIGS. 1 and 2A-2B.

In some implementations (e.g., implementations in which the wearablecomputing device is a fitness device), the fitness device may also beconfigured to provide additional feedback to the rescuer related to theeffort exerted by the rescuer while performing the CPR. The fitnessdevice may be configured to provide recommendations to the rescuer forhelping the rescuer improve the administered CPR without causing therescuer to become overtired. For example, if the fitness devicedetermines that the rescuer is exerting too much energy (e.g., based onthe rescuer's vitals as measured by the fitness device), the fitnessdevice may suggest that the rescuer adjust his or her posture,breathing, positioning, etc. Such feedback may be provided after the CPRhas been administered, so as not to distract the rescuer duringadministration. In some implementation, the fitness device may presentthe rescuer with a score indicative of both the CPR performance and therescuer's fitness performance during administration.

FIG. 3 shows a portable defibrillator 302 and ancillary componentsarranged to provide feedback and instruction to rescuers via a smartwatch 320. The smart watch 320 provides a display on which visualfeedback can be provided to a rescuer at a location that is away fromthe defibrillator unit 302, and more immediately in the line of sightand focus of attention of a rescuer.

In system 300, the defibrillator 302 is connected to an electrodeassembly by way of a wiring harness 304. The wiring harness 304 mayinclude a number of wire leads and may be connected to the defibrillator302 by way of a single plug. The wires may carry power from thedefibrillator 302, such as current to provide a shock to a victim who isbeing provided with emergency care, or to the defibrillator 302, such asin the form of signals for generating ECG information, accelerometerinformation, and measurements of trans-thoracic impedance of a victim.The electrode assembly in this example includes a first electrode 306, asecond electrode 308, and a chest compression assembly 310. The firstelectrode 306 may be configured to be placed above the victim's rightbreast, while the second electrode 308 may be configured to be placedbelow the victim's left breast. The chest compression assembly 310, inthis example, includes a detector 312 and a display 314. The detector312 may include a plastic housing within which an accelerometer assemblyis mounted. The accelerometer assembly may move with the housing aschest compressions are performed on a victim so that motion of theaccelerometer matches motion of the victim's sternum. The accelerometerin the housing may be connected to defibrillator 302 in order to passsignals through harness 304 (or may include a wireless transceiver forpassing the information wirelessly). The defibrillator 302 may beprovided with circuitry and/or software for converting such signals intothe indications regarding the rate and depth of compressions beingperformed on the victim, in manners such as those described below. Thedisplay 314 may provide feedback that is directed to the rescuer who isperforming chest compressions. In this example, the feedback can includesimilar feedback that is provided to the rescuer via the smart watch320. For example, the display 314 can show feedback about CPRperformance such as, an arrow indicating when the user is to performchest compressions more vigorously and circular cycling arrowsindicating when rescuers are to switch in performing chest compressions.In some examples, the accelerometer can be included in the watch 320.

The defibrillator 302 communicates with the smart watch 320 via awireless connection. For example, the defibrillator 302 can communicatewith the smart watch 320 using a wireless technology standard forexchanging data over short distances, such as Bluetooth technology,which uses short-wavelength radio transmissions in the ISM band from2400-2480 MHz to form personal area networks (PANs) with high levels ofsecurity. Thus, the defibrillator 302 and the smart watch 320 eachinclude a transmitter and a receiver for sending and receiving thewireless communications.

FIG. 4 shows an exemplary smart watch 400 used to capture informationfrom a rescuer and provide feedback to the rescuer via a display 412.One or more sensors can be used to capture information about therescuer. When the rescuer places the smart watch 400 on his or herwrist, the one or more sensors are placed in contact with the rescuer'sskin such that information about the physical state of the rescuer canbe monitored. For example, the smart watch 400 can include a bloodpressure sensor 402, a pulse oximetry sensor 404, and a colorimeter 408.In general, the pulse oximetry sensor 404 can be used to provide a(wirelessly) connected medical device, such as a defibrillator, withindications of the blood oxygen level and pulse rate of a rescuerwearing the device. In general, the blood pressure sensor can be used toprovide a connected medical device, such as the defibrillator, withindications of the blood pressure of the rescuer. The colorimeter 408 isconfigured to obtain a spectra based on an intensity of light reflectedprimarily from the epidermis and dermal papillae of an individual'sskin. The colorimeter 408 may take the form of a spectrophotometer,which generates spectral reflectance/absorbance data and provides aquantitative measurement of the reflection or absorption properties of amaterial as a function of wavelength. An exemplary colorimeter 408 isdescribed in US patent publication number 2014/0378779, filed on Jun. 4,2014, and titled “ANALYSIS OF SKIN COLORATION,” the contents of whichare hereby incorporated by reference in its entirety.

The smart watch 400 also includes a wireless transmitter/receiver 410.Information collected by the blood pressure sensor 402, pulse oximetrysensor 404, and colorimeter 408 can be sent to a remote processingdevice, such as a remotely located computing device, wearable computingdevice, or a computing device in a defibrillator via the wirelesstransmitter/receiver 410. Additionally, the smart watch 400 can receiveinformation from the remotely located computing device or the computingdevice in the defibrillator via the wireless transmitter/receiver 410.The information received by the wireless transmitter/receiver 410 can beused to provide feedback to the rescuer about his/her performance duringthe rescue event. For example, the smart watch 400 can receiveinformation to cause a display device 412 in the smart watch 400, adisplay in another type of wearable computing device, etc. to displayinformation and feedback to the rescuer, such as the information andfeedback described herein. Additionally, the smart watch 400, or anothertype of wearable computing device can receive commands to cause atactile feedback device, such as a buzzer or vibration device 408, toprovide additional stimulus to the user.

During use, the smart watch 400 is affixed around a user's wrist. Theentire watch (including display 412) is flexible such that the displayforms a curved surface and the various sensors located on the undersideof the device will contact the rescuer's skin. In some examples, thesmart watch 400 can include a band that is formed of layered, flexiblestainless steel bi-stable spring bands sealed within a fabric or plasticcover. The display 412 is incorporated into a top surface of the bandand the sensors 402, 404 and 406 are incorporated into a bottom oropposite surface of the band. The band can be straightened out, causingtension within the springy metal bands. The straightened bracelet isthen slapped against the wearer's forearm, causing the bands to springback into a curve that wraps around the wrist, securing the band to thewearer. Thus, no buckles or other fastening devices are required tosecure the smart watch 400 to the rescuer's wrist. Rather, an appliedforce or pressure causes the band of the device to assume a shape thatsecures itself to the rescuers wrist. In some examples, the smart watch400 can include a sensor or unit configured to sense when the smartwatch 400 is secured to the rescuer's wrist (e.g., sense when the shapeof the watch changes from being straight to being curved). The unitcauses the smart watch 400 to turn on (e.g., apply power to the unit)upon sensing that the smart watch 400 has been secured to the rescuer'swrist. Thus, the wearer does not need to take additional actions toturn-on the smart watch 400 because the smart watch 400 turns onautomatically upon modification of the shape of the band.

As described above, the smart watch device can include sensors thatmonitor the rescuer. Such values may then be used either independentlyor along with other factors, such as rate and depth of compressions, todetermine when the rescuer should be instructed to stop performing chestcompressions and yield to another rescuer. Also, the feedback providedto the rescuer on the smart watch or other type of wearable computingdevice can integrate information about rescuer blood oxygen level,pulse, or both in order to determine the feedback to be provided to therescuer. Thus, for example, a processor in the wrist-worn device, adevice interface of another type of wearable computing device, etc. mayreceive signals from the sensors and convert them partially or fullyinto blood oxygen and pulse rate values that can then be displayed orfurther processed (e.g., to identify that the rescuer is becomingfatigued).

In one example, as shown in FIG. 5, feedback can be provided using avisual indicator on the smart watch indicating that the rescuer shouldchange places with another rescuer. While the visual indicator isgenerally shown on the smart watch, the visual indicator can also bedisplayed on a display of a wearable computing device. In this example,cycling arrows 502 are displayed on the smart watch display screen. Sucharrows may indicate to the rescuers that it is time for them to switchtasks. Using the example shown in FIG. 1, providing a rescuer swapindicator can indicate that that rescuer 104 should cease providingchest compressions and begin operating the ventilation bag 112 andrescuer 106 should cease controlling the ventilation and instead beganproviding chest compressions on electrode assembly 110. When there arethree or more rescuers, the third rescuer may have been resting and cantake over chest compressions for rescuer 104 when a rescuer change isdirected by the system. The rescuer 104 may then rest or switch fromproviding chest compressions to providing ventilation assistance whilerescuer 106 rests or does something else. The defibrillator may causethe cycling arrows 502 to be displayed based on the occurrence ofvarious events. In one example, the cycling arrows 502 may be displayedafter a set time period has elapsed since rescuer 104 began applyingchest compressions. A particular CPR protocol may require switching ofrescuers at certain predefined periodic intervals (e.g., every 2minutes). As described previously as well as below in more detail, thecycling arrows 502, or a similar cycling signal, may alternatively begenerated according to determinations made by the defibrillatorregarding the level of rescuer fatigue. The defibrillator may thus beprogrammed to identify when factors indicate the rescuer's physicalstate (e.g., via pulse measurement) has started to decline. For example,a heart rate monitor in the smart watch can measure an increase in heartrate that may indicate fatigue by the rescuer and may be used togenerate a signal to switch rescuers. A rescuer fatigue score can becalculated and compared to a threshold such that when the rescuerfatigue score exceeds the threshold, the system indicates that therescuer should allow someone else to take over, by displaying cyclingarrows 502, for example. In another example the system combinesinformation about the length of time the rescuer has performed CPR withthe rescuer fatigue information to determine a rescuer fatigue score.

FIG. 6 is a flowchart of a process for monitoring CPR performance and arescuers physical state and providing feedback for improvement of theperformance. Generally, the process involves automatic monitoring of theperformance of a component of CPR, such as the provision of chestcompressions to a victim, and providing an indication of when theprovider/rescuer should stop performing the component and allow anotherrescuer to take over.

The process begins at box 602, where it monitors the physical state ofthe rescuer using various sensors included in a wrist-worn device. Forexample, the process can receive data indicative of one or more of thepatient's blood pressure, heart rate, and inspired CO2. At box 604, thisdata is sent to a computing device. For example, the data can be sentfrom the wrist-worn device to a computing device in a defibrillatorusing a wireless protocol.

At box 606, the process monitors chest compressions via an accelerometerpuck. For example, the rescuer may have applied the electrodes and thepuck and have begun performing chest compressions on the victim. Suchcompressions may cause the puck to move and accelerate up and down, sothat an accelerometer in the puck generates signals indicative of suchacceleration. The defibrillator may receive such signals and convertthem into indications of the quality of the chest compression, such asindications of how deep each chest compression is and the pace at whichparticular ones of the chest compressions are occurring.

At box 608, the process generates feedback related to the rescuer'sperformance of CPR and provides the feedback to the rescuer on a displayof the wearable computing device. In some examples, the feedback canalso be displayed on the smart-watch device. This information caninclude the depth and rate of chest compressions. Additionally, thefeedback provided to the rescuer can include information about thepatient status, such as a display of the ECG or SpO2 signaled.

At box 610, the process calculates a fatigue score based on the receivedrescuer monitoring data alone or in combination with the observed priorchest compressions. For example, the fatigue score may be computed as afunction of the measured physical status of the rescuer. In anotherexample the fatigue score may be computed as a function of the measuredphysical status of the rescuer in combination with the depth and rate ofone or more chest compressions that have been observed from theaccelerometer puck.

At box 512, a determination is made with regard to whether or not thefatigue score indicates a need to change the roles of the rescuers. Forexample, if a fatigue score is below a threshold that indicates anacceptable level of fatigue, the process returns back to box 502 andcontinues monitoring a rescuers physical status and the chestcompressions using the accelerometer puck as well as determining thefatigue scores.

If the fatigue score exceeds the threshold indicating that the rescuerhas begun to fatigue, at box 514, the process provides an indication tothe rescuer, and perhaps to others, that a provider of care shouldchange. For example, the smart watch can provide a visual indicationthat the provider of care should change. In addition, haptic feedbackmay be provided to the rescuer, such as switching from periodic(metronomic) vibration in a unit in the wrist-worn device to continuousvibration in the wrist-worn device, or another change in haptic feedbackthat differs from the feedback given when no change is to be made.

Using such a process, a system may then adjust to the capabilities ofvarious caregivers and maintain caregivers in a position to provide aparticular component of care as long as they are able to provide for it.As a result, the system need not be stuck to preset time limits thatmight not reflect the actual standard of care that can be adequatelyprovided, but can instead vary based on the actual standard of care thatis being given by a particular rescuer team in a particular situation.The process could result in better outcomes for victims tended to bysuch rescuers, and in a better experience for the rescuers themselves.

In systems where smart watches or other types of wearable computingdevices communicate wirelessly with a central computing device, such asthe defibrillator, it is important to ensure that the smart watches orother devices are paired with the correct central computing device. Forexample, as shown in FIG. 7, at the scene of a mass casualty or massrescue event, there can be multiple different patients 702, 750. It isessential that the smart watches or other types of wearable computingdevices for a particular patient are correctly paired with the computingdevice or defibrillator associated with that patient. For example, thesmart watches 784 and 782 should be wirelessly connected with thecentral computing element in defibrillator 710 while the smart watch 780should be wirelessly connected to the central computing element indefibrillator 760. If, for example, the smart watches 784 and 782associated with patient 702 were instead mistakenly wirelessly connectedto defibrillator 760. The information displayed to the wearers would notbe accurate. Additionally, the decisions of if/when to switch rescuersmight be incorrect. In an extreme case, if patient 702 regained bloodcirculation and breathing and the sensors were mistakenly connected tothe defibrillator 760, defibrillator 760 could erroneously instruct therescuer 756 to discontinue administration of CPR on victim 750. Inanother example, if ECG information were erroneously transmitted to anincorrectly matched defibrillator, the defibrillator could erroneouslyshock a victim whose heart rhythm was non-shockable. In order to preventsuch detrimental situations, it is important to ensure that the sensorsare paired with the correct central computing device. While this pairingprocess is generally described with respect to the smart-watches,similar methods can be used to pair other types of wearable computingdevices.

Correct pairing of a smart watch, other types of wearable computingdevices, etc. with the patient-specific, localized network occurs whenthe smart watch is connected to the wireless network. Smart watches orother types of wearable computing devices (and thereby the rescuers) canjoin and leave various networks so that they can aid in different rescueattempts. For example, as rescuer 756 begins to fatigue, rescuer 706might leave the rescue attempt for victim 702 and join the rescueattempt for victim 750. In doing so, the information displayed on thesmart watch 782 worn by rescuer 706 should be changed to display thedata for victim 750.

Various mechanisms can be used to allow a rescuer (and their smartwatch, other type of wearable computing devices, etc.) to join/leave aparticular network. For example, the smart watch can have a touch menuallowing the user to select a particular network from a list ofnetworks. In another example, the smart watch can include mechanismsthat allow a particular network to be selected based on actions of theuser/watch without requiring the user to know and select the network.For example, a bump-to-join process could be executed in which, upon twosmart watches contacting one another, the second smart watch joins thenetwork of the first.

FIG. 8 shows a process for adding a smart watch to a network associatedwith a particular defibrillator/patient. The process begins with awearer of a smart watch desiring to join a particular network associatedwith a rescue attempt. The wearer places the smart watch into a discovermode (802). In the discover mode, the smart watch is granted/deniedaccess to the network based on the concurrent receipt of signals frommultiple smart watches. The concurrently received signals are indicativeof the wearer's association with a particular rescue team. For example,in the scene of a mass rescue attempt where multiple different networksexist, the rescuer is connected to the correct network associated withthe victim they will aid (e.g., as described in relation to FIG. 7)based on the concurrently received signals. The defibrillator or centralcomputing device receives an indication of vibration from the watch indiscover mode and from another watch already associated with the network(804). For example, each of the smart watches can include anaccelerometer and the two wearers can shake hands or give a high fivesuch that the accelerometers in each of the watches will concurrentlymeasure a motion. The defibrillator or central computing devicedetermines whether the vibrations were concurrently received from bothwatches (806). If the measured vibrations were concurrent, the systemallows the smart watch in discovery mode to join the wireless network ofthe watch already associated with the network (808). Thus, a particularnetwork is selected from amongst multiple different networks based onthe network associated with the watch for which the concurrent signalwas received. If the measured vibrations were not concurrent, the systemreturns to receiving vibration indications from the watch. While thispairing process is generally described with respect to thesmart-watches, similar processes can be used to adding a wearablecomputing device to a network associated with a particulardefibrillator/patient pair.

In some examples, a central management system can be connected to one ormore smart watches and to other computing devices, e.g., other wearablecomputing devices, and the defibrillator associated with a patientrescue. As such, the central management unit can gather informationabout the rescue attempt and information about the rescuer performance.

In one particular example, FIG. 9 shows a system 900 for responding toan emergency medical condition of a victim 902. In general, system 900includes various portable devices for monitoring on-site care given tothe victim 902. The various devices may be provided by emergency medicaltechnicians who arrive at the scene and who provide care for the victim702, such as emergency medical technicians 906, 907 and 914. In thisexample, the emergency medical technician technicians 906, 907 and 914have deployed several devices and are providing care to the victim 902.The emergency medical technician 914 in this example is interacting witha computing device in the form of a touchscreen tablet 916. In someexamples, the emergency medical technicians 906, 907 and 914 mayinteract with a wearable computing device in the form of wearableglasses (as shown in FIG. 1). The tablet 916 may include a graphicaldisplay by which to report information to the emergency medicaltechnician 914. A portable defibrillator 912 is shown in a deployedstate and is connected to the victim 902. In addition to providingdefibrillation, the defibrillator 912 may serve as a patient monitor viaa variety of sensors or sensor packages. For example, as shown here,electrodes have been applied to the bare chest of the victim 902 andhave been connected to the defibrillator 912, so that electricalshocking pulses may be provided to the electrodes in an effort todefibrillate the victim 902, and electrocardiogram (ECG) signals may beread from the victim 902. The defibrillator 912 may provide feedback ina conventional and known manner to a rescuer, such as emergency medicaltechnician 914.

The defibrillator 912 may communicate through a short range wirelessdata connection with the tablet 916. The defibrillator 912 can provideto the tablet 916 status information, such as information receivedthrough the electrode assembly, including ECG information for the victim902. Also, the defibrillator 912 can send information about theperformance of chest compressions, such as depth and rate informationfor the chest compressions. The tablet 916 can also receive data fromthe other sensors associated with the victim 902 such as an airflowsensor provided with a ventilation bag. The tablet 916 can also receivedata from smart watches 984 and 982 worn by rescuers 906 and 907respectively. The information from smart watches 984 and 982 can includeinformation about the fatigue level of the rescuer (e.g., as describedherein).

A central server system 920 may communicate with the tablet 916 or otherdevices at the rescue scene over a wireless network and a network 918,which may include portions of the Internet (where data may beappropriately encrypted to protect privacy). The central server system920 may be part of a larger system for a healthcare organization inwhich medical records 932 are kept for various patients in the system.Information about the patient 902 may then be associated with anidentification number or other identifier, and stored by the centralserver system 920 for later access. Additionally, the central serversystem 920 may store records 932, 934, 936 that include informationassociated with each of the rescuers for various rescuers in the system.Information about the each of the rescuers may then be associated withan identification number or other identifier, and stored by the centralserver system 920 for later access. This information can include eachrescue attempt in which the rescuer participated and their role in therescue. Additionally, the information about the rescuer can includeinformation about his/her fatigue level which is received from the smartwatch, other types of wearable computing devices, etc. worn by therescuer.

Other users may then access the data in the central server system 920.For example, as shown here, an emergency room physician 922 is operatinghis or her own tablet 924 that communicates wirelessly, such as over acellular data network. As such, the physician 922 may review the datafrom central server system 920. In this manner, the system 900 permitsvarious portable electronic devices to communicate with each other so asto coordinate care that is provided to a victim 902. In addition, thesystem 900 allows the technician 914 and others to see raw real-timedata and derived real-time or historical data about a rescue attempt.

In some implementations, other data provided by wrist-worn devices(e.g., the wrist-worn devices 200, 202 of FIGS. 2A and 2B), includingthe calculated CPR metrics and/or feedback information described above,may also be provided to the central server system 920 and accessed byother users, such as the emergency room physician 922. Such data mayalso or alternatively be provided by the smart watches 922, 924. Thedata may be provided in real time. For example, the calculated CPRmetrics and/or the feedback information can be provided and accessed inreal time such that remote medical personnel can continuously monitorthe administration of the CPR to verify proper compliance. Thecalculated CPR metrics may include a score (e.g., a chest compressionquality score) indicative of the overall quality in the performance ofCPR which may aggregate multiple parameters/data monitored during theact of CPR and/or shortly thereafter.

Many other implementations other than those described may be employed,and may be encompassed by the following claims.

What is claimed is:
 1. A system comprising: a wrist-worn deviceconfigured to be worn on the wrist of a rescuer performingcardiopulmonary resuscitation (CPR), the wrist-worn device including:one or more sensors coupled with the wrist-worn device, the one or moresensors being configured to sense one or more parameters indicative of afatigue level of the rescuer; and a sensor interface configured toprovide the sensed parameters to one or more external computing devicesvia an interface; and a wearable computing device configured to be wornby a rescuer, the wearable computing device including: a deviceinterface for receiving information related to CPR; and a display fordisplaying an indication of the received information.
 2. The system ofclaim 1, wherein the wrist-worn device includes: a wrist-worn displayformed of a flexible material configured to wrap around the wrist; and acontroller arranged to receive information related to CPR from at leastone of the sensors and external computing devices and display anindication on the wrist-worn display related to the receivedinformation.
 3. The system of claim 1, wherein the wearable computingdevice receives the information related to CPR from the wrist-worndevice.
 4. The system of claim 1, wherein the wearable computing devicereceives the information related to CPR from one or more of the externalcomputing devices.
 5. The system of claim 1, wherein in response tosensing the one or more parameters indicative of a fatigue level of therescuer, the device interface is configured to receive an indication toswitch rescuers, and the wearable computing device is configured todisplay an indication on the display related to the received indicationto switch rescuers.
 6. The system of claim 1, wherein the wearablecomputing device includes wearable glasses.
 7. The system of claim 6,wherein the display is formed on at least one lens of the wearableglasses.
 8. The system of claim 1, wherein the wrist-worn deviceincludes a band formed of multiple springy metal bands.
 9. The system ofclaim 1, wherein the one or more sensors comprise sensors configured tomonitor at least one of a heart rate and a blood pressure of therescuer.
 10. The system of claim 1, comprising: an electronic patientmonitor; a sensor interface on the electronic patient monitor arrangedto receive input from one or more sensors that sense one or moreparameters indicative of a CPR quality level; and a CPR monitor in theelectronic patient monitor configured to use the input from the sensorsto identify a quality parameter and to provide information associatedwith the quality parameter to the wrist-worn device.
 11. The system ofclaim 10, wherein the electronic patient monitor is part of an externaldefibrillator.
 12. The system of claim 10, wherein the CPR monitorcomprises a microprocessor connected to an electronic memory that storesinstructions that, when executed, perform a process of identifying aquality parameter that reflects one or both of a depth of chestcompressions and a rate of chest compressions.
 13. The system of claim1, wherein the display is configured to provide feedback to a rescuerindicating a way to improve a CPR component.
 14. The system of claim 1,wherein the wrist-worn device comprises a memory configured to store aunique identifier associated with the wrist-worn device.
 15. The systemof claim 1, wherein the wrist-worn device is configured to power on whenthe wrist-worn device wraps around the wrist.
 16. The system of claim 1,comprising a heads-up device to provide feedback to a user related toCPR performance based on one or more parameters associated with the CPRperformance.
 17. A system comprising: a wrist-worn device configured tobe worn on the wrist of a rescuer performing CPR, the wrist-worn deviceincluding: one or more sensors coupled with the wrist-worn device, theone or more sensors being configured to sense one or more parametersindicative of a fatigue level of the rescuer; and a sensor interface toprovide the sensed parameters to one or more external computing devicesvia an interface; and a heads-up device configured to be viewed by arescuer, the heads-up device including: a device interface for receivinginformation related to CPR; and a display for displaying an indicationof the received information.
 18. The system of claim 17, wherein thedisplay is configured to present the indication via a projected image.19. A method comprising: monitoring, with a sensor coupled with awrist-worn device, one or more parameters indicative of a status of auser wearing the wrist-worn device; determining a fatigue score relatedto a level of fatigue of the user; determining whether the user isexhibiting fatigue based on the fatigue score; and providing anindication to the user that a different user should perform a CPRcomponent.
 20. The method of claim 19, comprising repeating the actionsof monitoring, determining, and providing, while multiple differentusers are instructed to perform the CPR component.
 21. The method ofclaim 19, wherein the CPR component comprises chest compressions. 22.The method of claim 19, comprising sending, to a wearable computingdevice worn by the user, information related to the CPR component. 23.The method of claim 22, wherein the wearable computing device includeswearable glasses.
 24. The method of claim 23, wherein a display isformed on at least one lens of the wearable glasses.
 25. The method ofclaim 22, wherein the information related to the CPR component includesone or more parameters indicative of a quality level of the CPRcomponent, the one or more parameters including one or more of depth ofcompression and rate of compression, wherein determining the fatiguescore includes determining the fatigue score based on the one or moreparameters, the one or more parameters also indicating a physical statusof the user.
 26. The method of claim 25, comprising generating a chestcompression quality score based on one or both of the rate ofcompression and the depth of compression, and providing an indication ofthe chest compression quality score to the wearable computing device.27. The method of claim 24, comprising providing periodic feedback tothe user by causing information representing one or both of chestcompression depth and chest compression rate to be presented on thedisplay.
 28. The method of claim 19, wherein the status comprises aphysical status.
 29. The method of claim 19, comprising transmitting thefatigue score to a central management system.
 30. A method comprising:receiving, from a sensor coupled with a wrist-worn device, one or moreparameters indicative of a status of a user wearing the wrist-worndevice; determining, based on the one or more parameters, a fatigueindication associated with a fatigue level of the user; and sending, toa wearable computing device, information to cause the wearable computingdevice to provide an indication to the user that a different user shouldperform a CPR component.
 31. The method of claim 30, wherein the CPRcomponent comprises chest compressions.
 32. The method of claim 30,wherein the wearable computing device includes wearable glasses.
 33. Themethod of claim 30, comprising receiving one or more parametersindicative of a quality level of the CPR component, the one or moreparameters including one or more of depth of compression and rate ofcompression, wherein determining the fatigue indication comprisesdetermining the fatigue indication based on the one or more parameters,the fatigue indication being indicative of a physical status of theuser.
 34. The method of claim 30, comprising: receiving informationrelated to one or both of a depth of chest compressions and a rate ofchest compressions; generating a chest compression quality score basedon one of both of the depth of chest compressions and the rate of chestcompressions; and sending, to the wearable computing device, informationto cause the wearable computing device to display informationrepresenting the chest compression quality score.
 35. The method ofclaim 30, wherein the status comprises a physical status.
 36. A computerreadable medium storing instructions for causing a computing system to:monitor, with a sensor coupled with a wrist-worn device, one or moreparameters indicative of a status of a user; determine a fatigue scorerelated to a level of fatigue of the user of the wrist-worn device;determine that the user is exhibiting fatigue based on the fatiguescore; and provide an indication that a user other than the user of thewrist-worn device should perform a CPR component.
 37. The computerreadable medium of claim 36, wherein the instructions cause the systemto cyclically repeat the actions of monitoring, determining, andproviding, while multiple different users are instructed to perform theCPR component.
 38. The computer readable medium of claim 36, wherein theCPR component includes chest compressions.
 39. The computer readablemedium of claim 36, wherein the indication is provided to a wearablecomputing device that includes wearable glasses.
 40. The computerreadable medium of claim 39, wherein a display is formed on at least onelens of the wearable glasses.